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Community screening for visual impairment in the elderly

Visual impairment is common among older people and is associated with falls and reduced quality of life. Visual problems in older people are often not reported to medical services. Screening has been recommended because vision could be improved by encouraging treatment in the majority of older people with impaired vision. The review found five studies in which vision was tested as part of a broader screening assessment. No improvement in vision was seen two to four years after screening compared to elderly people who were not screened. This may be due to the lack of a clear plan of intervention for visual problems found on screening. In another study, the risk of having visual impairment in either eye was similar with universal and targeted screening, three to five years after screening.

Authors' conclusions:

There is no evidence that community-based screening of asymptomatic older people results in improvements in vision.

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Background:

While the aims of multicomponent screening of older people are broad, any benefit arising from the inclusion of a vision component in the assessment will necessarily be dependent on improving vision.

Objectives:

To assess the effects on vision of mass screening of older people for visual impairment.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 1, 2008), MEDLINE (1966 to February 2008), EMBASE (1980 to February 2008), PubMed (on 8th March 2006; last 90 days), UK Clinical Trials Gateway on 29 February 2008, SciSearch and reference lists of relevant trial reports and review articles. We contacted investigators to identify additional published and unpublished trials.

Selection criteria:

We included randomised trials of visual or multicomponent screening for identifying vision impairment in people aged 65 years or over in a community setting.

Data collection and analysis:

Both authors independently extracted data and assessed trial quality.

Main results:

Visual outcomedata were available for 3494 people in five trials of multicomponent assessment. Length of follow up ranged from two to four years. All the trials used self-reported measures for visual impairment, both as screening tools and as outcome measures. In four of the trials people reporting visual problems were referred to either eye services or a physician. In one trial people reporting visual problems received information about resources in the community designed to assist those with poor vision. The proportions of participants in the intervention and control groups who reported visual problems at the time of outcome assessment were 0.26 and 0.23 respectively (risk ratio for visual impairment 1.03, 95% confidence interval (CI) 0.92 to 1.15). Visual outcomedata were also available for 1807 people aged 75 years and over in a cluster randomised trial in which physicians' general practices were randomised to two different screening strategies; universal or targeted. Three to five years after screening, the risk ratio for visual acuity less than 6/18 in either eye comparing universal with targeted screening was 1.07 (95% CI 0.84 to 1.36, P = 0.58). The mean composite score of the National Eye Institute 25 item visual function questionnaire was 85.6 in the targeted screening group and 86.0 in the universal group, a difference of 0.4 (95% CI -1.7 to 2.5, P = 0.69).

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